DOING YOUR BREAST SELF-EXAMINATION
Begin while lying in bed. Place a pillow or folded towel under your left shoulder (picture 1) and your left hand behind your head. Your shoulder should be raised high enough for your left breast to be centered on top of your chest, falling neither to the centre nor towards the armpit; this arrangement distributes the breast tissue as evenly as possible across the chest wall. If a breast is not properly flattened against the chest, it is difficult to feel a lump particularly in the outer upper quadrant, where tissue is thicker (and where most malignancies occur).
Palpation and systematic feeling of your breasts, will give you a "touch picture" of their normal structure and condition. Always use your right hand to examine your left breast, and vice-versa. Use two or three fingers, keeping the thumb extended, and always feel with the sensitive "palmar pads" on the flat, inner surfaces of your fingers. Do not use your fingertips; they are less sensitive, and long fingernails will impede your examination. Never compress your breast between thumb and fingers as this may cause you to feel a "lump" that does not exist.
Palpate your breasts with small rotary motions, pressing gently but firmly to immobilize the skin and roll it over the underlying tissue. (Merely sliding the fingertips over the skin does not tell you anything about conditions below the surface. To demonstrate the difference, and practice the correct method of palpation, use two fingers of one hand to feel the back of the other: gliding the fingertips over the skin reveals little of the structure beneath; but pressing gently with flat pads of the fingers immobilizes the skin and moves it along with the fingers, so that you feel the bones, tendons, etc under the surface).
What to feel for
Carefully notice the "feel" of your normal breast structure, so that you can remark at once any changes from what is usual for you. Many women have a normal thickening or ridge of firm tissue under the lower curve of the breast, at its attachment to the chest wall; also the large milk ducts can be felt as a ring of "bumps" at the outer edge of the areola. In very slender women, the bony prominence of the chest wall may be mistaken for breast tumors, as may enlarged milk glands, fat tumors, lymph nodes, or benign cysts. All such thickenings should be palpated carefully during each monthly BSE, in order to distinguish stable, normal conditions from potentially dangerous changes. Any lump or other change found in one breast only (especially in the upper, outer quadrant) is more likely to be serious than a change, which has a mirror image in the other breast. If in doubt about ANY development, consult your doctor.
What to Look for
Note the contours and relative placement of your breasts; the appearance of the areola and nipples; any distortions of discolorations of the skin or surface texture; and their movement as you move your arms and chest muscles. Consider any medical factors (injury, surgery, etc.) or activities (one-sided exercise, such as bowling, tennis, operating machinery, etc) that might account for either differences or changes in symmetry.